0
September 6, 1995, Vol 274, No. 9 >
ARTICLE | September 6, 1995

Changing Physician Performance: Title and subTitle BreakA Systematic Review of the Effect of Continuing Medical Education Strategies FREE

David A. Davis, MD; Mary Ann Thomson, BHSc; Andrew D. Oxman, MD; R. Brian Haynes, MD, PhD
[+] Author Affiliations

Corresponding author: Office of Continuing Education, Faculty of Medicine, University of Toronto, 150 College St, Toronto, Ontario, Canada M5S 1A8 (Dr Davis).


JAMA. 1995;274(9):700-705. doi:10.1001/jama.1995.03530090032018
Text Size: A A A
Published online
Article
References

Objective.  —To review the literature relating to the effectiveness of education strategies designed to change physician performance and health care outcomes.

Data Sources.  —We searched MEDLINE, ERIC, NTIS, the Research and Development Resource Base in Continuing Medical Education, and other relevant data sources from 1975 to 1994, using continuing medical education (CME) and related terms as keywords. We manually searched journals and the bibliographies of other review articles and called on the opinions of recognized experts.

Study Selection.  —We reviewed studies that met the following criteria: randomized controlled trials of education strategies or interventions that objectively assessed physician performance and/or health care outcomes. These intervention strategies included (alone and in combination) educational materials, formal CME activities, outreach visits such as academic detailing, opinion leaders, patient-mediated strategies, audit with feedback, and reminders. Studies were selected only if more than 50% of the subjects were either practicing physicians or medical residents.

Data Extraction.  —We extracted the specialty of the physicians targeted by the interventions and the clinical domain and setting of the trial. We also determined the details of the educational intervention, the extent to which needs or barriers to change had been ascertained prior to the intervention, and the main outcome measure(s).

Data Synthesis.  —We found 99 trials, containing 160 interventions, that met our criteria. Almost two thirds of the interventions (101 of 160) displayed an improvement in at least one major outcome measure: 70% demonstrated a change in physician performance, and 48% of interventions aimed at health care outcomes produced a positive change. Effective change strategies included reminders, patient-mediated interventions, outreach visits, opinion leaders, and multifaceted activities. Audit with feedback and educational materials were less effective, and formal CME conferences or activities, without enabling or practice-reinforcing strategies, had relatively little impact.

Conclusion.  —Widely used CME delivery methods such as conferences have little direct impact on improving professional practice. More effective methods such as systematic practice-based interventions and outreach visits are seldom used by CME providers.(JAMA. 1995;274:700-705)

REFERENCES

1 +
References 17, 19, 35, 71, 74, 84, 86, 110, 111.
2 +
References 14,20,27,31,37,41,56,57,80,85,89, 91, 93-96, 105, 106, 108, 112.
3 +
References 17, 22,26,29,34,52,63-66,71,75, 78, 79, 86, 87, 98-102, 104.
4 +
References 19, 31, 42, 46, 58, 59, 70, 72, 85, 99.
5 +
References 19, 38, 41, 80, 85, 92, 97, 111, 112.
6 +
References 27,30,33,37,39, 41,48,55,57,58,65, 68, 70, 83, 84, 89, 96, 102, 106, 110.
7 +
References 19, 33, 38, 40, 44, 47, 60, 76, 82, 97, 105, 107.
8 +
References 14, 18, 20, 26, 28, 33, 39, 44, 53, 56, 60-62, 69, 73, 77, 81, 91, 103, 109.
9 +
References 21, 26, 29, 34, 39, 48, 52, 59, 66, 68, 69, 73, 75, 87, 98, 99, 102, 104, 110.
10 +
References 19, 20, 28, 31, 37, 41, 56-58, 77, 85,100, 101.
11 +
References 15, 16, 22, 42, 46, 62, 70, 84, 91, 92.
12 +
Amara R, Morrison JI, Schmid G. Looking Ahead at American Health Care . Institute for the Future, Healthcare Information Center, Washington, DC: McGraw-Hill International Book Co; 1988;.
13 +
Association of American Medical Colleges.  Roles for medical education in health care reform. Acad Med . 1994;;69:512-515.
14 +
Pories WJ, Smout JC, Morris A, Lewkow VE.  US health care reform: will it change postgraduate surgical education? World J Surg . 1994;;18:745-752.
15 +
Haynes RB, Davis DA, McKibbon A, Tugwell P.  A critical appraisal of the efficacy of continuing medical education. JAMA . 1984;;251:61-64.
16 +
Davis DA, Thomson MA, Oxman AD, Haynes RB.  Evidence for the effectiveness of CME: a review of 50 randomized controlled trials. JAMA . 1992;;268:1111-1117.
17 +
Lau J, Antman EM, Jimenez-Silva J, Kupelnick B, Mosteller F, Chalmers TC.  Cumulative meta-analysis of therapeutic trials for myocardial infarction. N Engl J Med . 1992;;327:248-254.
18 +
Jay SJ, Anderson JG.  Continuing medical education and public policy in an era of health care reform. J Contin Educ Health Profess . 1993;;13:195-209.
19 +
Oxman AD, Thomson MA, Haynes RB, Davis DA.  No magic bullets: a systematic review of 102 trials of interventions to help health care professionals deliver services more effectively and efficiently. Can Med Assoc J . In press.
20 +
Bertram DA, Brooks-Bertram PA.  The evaluation of continuing medical education: a literature review. Health Educ Monogr . 1977;;5:330-362.
21 +
Beaudry JS.  The effectiveness of continuing medical education: a quantitative synthesis. J Contin Educ Health Profess . 1989;;9:285-307.
22 +
McLaughlin PJ, Donaldson JF.  Evaluation of continuing medical education programs: a selected literature, 1984-1988. J Contin Educ Health Profess . 1991;;11:65-84.
23 +
Cochrane Collaboration. Optimal MEDLINE Search Strategy for Identifying Randomized Clinical Trials (RCTs): Cochrane Collaboration Handbook . Oxford, England: UK Cochrane Centre; 1994;: 29.
24 +
Davis DA, Fox RD, eds. The Physician as Learner: Linking Research to Practice . Chicago, Ill: American Medical Association Press; 1994;:xiii.
25 +
Anderson FA Jr, Wheeler HB, Goldberg RJ, Hosmer DW, Forcier A, Patwardhan NA.  Changing clinical practice: prospective study of the impact of continuing medical education and quality assurance programs on use of prophylaxis for venous thromboembolism. Arch Intern Med . 1994;; 154:669-677.
26 +
Avorn J, Soumerai SB.  Improving drug-therapy decisions through educational outreach: a randomized controlled trial of academically based 'detailing.' N Engl J Med . 1983;;308:1457-1463.
27 +
Avorn J, Soumerai SB, Everitt DE, et al.  A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes. N Engl J Med . 1992;;327:168-173.
28 +
Barnett GO.  A computer based monitoring system for follow-up of elevated blood pressure. Med Care . 1983;;21:400-409.
29 +
Bass MJ, McWhinney IR, Donner A.  Do family physicians need medical assistants to detect and manage hypertension? Can Med Assoc J . 1986;;134: 1247-1255.
30 +
Berwick DM, Coltin KL.  Feedback reduces test use in a health maintenance organization. JAMA . 1986;;255:1450-1454.
31 +
Billi JE, Hejna GF, Wolf FM, Shapiro LR, Stross JK.  The effects of a cost-education program on hospital charges. J Gen Intern Med . 1987;;2:306-311.
32 +
Brimberry R.  Vaccination of high-risk patients for influenza: a comparison of telephone and mail reminder methods. J Fam Pract . 1988;;26:397-400.
33 +
Britton ML, Lurvey PL.  Impact of medication profile review on prescribing in a general medicine clinic. Am J Public Health . 1991;;48:265-270.
34 +
Browner WS, Baron RB, Solkowitz S, Adler LJ, Gullion DS.  Physician management of hypercholesterolemia: a randomized trial of continuing medical education. West J Med . 1994;;161:572-578.
35 +
Buntinx F.  Does feedback improve the quality of cervical smears? a randomized controlled trial. Br J Gen Pract . 1993;;43:194-198.
36 +
Callahan CM, Hendrie HC, Dittus RS, Brater DC, Hui SL, Tierney WM.  Improving treatment of late life depression in primary care: a randomized clinical trial. J Am Geriatr Soc . 1994;;42:839-846.
37 +
Chambers CV, Balaban DJ, Carlson BL.  Microcomputer-generated reminders: improving the compliance of primary care physicians with mammography screening guidelines. J Fam Pract . 1989;; 29:273-280.
38 +
Chase CR.  Medical information management: improving the transfer of research results to pre-surgical evaluation. Med Care . 1983;;21:410-424.
39 +
Chassin MR, McCue SM.  A randomized trial of medical quality assurance: improving physicians' use of pelvimetry. JAMA . 1986;;256:1012-1016.
40 +
Cheney C, Ramsdell JW.  Effect of medical records' checklists on implementation of periodic health measures. Am J Med . 1987;;83:129-136.
41 +
Cockburn J, Ruth D, Silagy C, et al.  Randomised trial of three approaches for marketing smoking cessation programmes to Australian general practitioners. BMJ . 1992;;304:691-694.
42 +
Cohen DI, Jones P, Littenberg B, Neuhauser D.  Does cost information availability reduce physician test usage? a randomized clinical trial with unexpected findings. Med Care . 1982;;20:286-292.
43 +
Cohen SJ, Christen AG, Katz BP, et al.  Counseling medical and dental patients about cigarette smoking: the impact of nicotine gum and chart reminders. Am J Public Health . 1987;;77:313-316.
44 +
Cohen SJ, Weinberger M, Hui SL, Tierney WM, McDonald CJ.  The impact of reading on physicians' nonadherence to recommended standards of medical care. Soc Sci Med . 1985;;21:909-914.
45 +
Cowan JA.  Effect of a fact sheet reminder on performance of the periodic health examination: a randomized controlled trial. Am J Prev Med . 1992;; 8:104-109.
46 +
Cummings SR, Coates TJ, Richard RJ, et al.  Training physicians in counselling about smoking cessation: a randomized trial of the 'Quit for Life' program. Ann Intern Med . 1989;;110:640-647.
47 +
Cummings SR, Richard RJ, Duncan CL, et al.  Training physicians about smoking cessation: a controlled trial in private practice. J Gen Intern Med . 1989;;4:482-489.
48 +
Davidoff F, Goodspeed R, Clive J.  Changing test ordering behavior: a randomized controlled trial comparing probabilistic reasoning with cost-containment education. Med Care . 1989;;27:45-58.
49 +
Dickinson JC.  Improving hypertension control: impact of computer feedback and physician education. Med Care . 1981;;19:843-854.
50 +
Dietrich AJ.  Cancer: improving early detection and prevention, a community practice randomised trial. BMJ . 1992;;304:687-691.
51 +
Evans CE, Haynes RB, Birkett NJ, et al.  Does a mailed continuing education program improve physician performance? results of a randomized trial in antihypertensive care. JAMA . 1986;;255:501-504.
52 +
Everett GD, deBlois CS, Chang PF, Holets T.  Effect of cost education, cost audits, and faculty chart review on the use of laboratory services. Arch Intern Med . 1983;;143:942-944.
53 +
Gehlbach SH, Wilkinson WE, Hammond WE, et al.  Improving drug prescribing in a primary care practice. Med Care . 1984;;22:193-201.
54 +
Gullion DS, Tschann JM, Adamson TE, Coates TJ.  Management of hypertension in private practice: a randomized controlled trial in continuing medical education. J Contin Educ Health Profess . 1988;;8:239-255.
55 +
Headrick LA, Speroff T, Pelecanos HI, Cebul RD.  Efforts to improve compliance with the National Cholesterol Education Program guidelines: results of a randomized controlled trial. Arch Intern Med . 1992;;152:2490-2496.
56 +
Heale J, Davis DA, Norman GR, Woodward C, Neufeld VR, Dodd P.  A randomized controlled trial assessing the impact of problem based versus didactic teaching methods in CME. Proc Annu Conf Res Med Educ . 1988;;27:72-77.
57 +
Hershey CO, Goldberg HI, Cohen DI.  The effect of computerized feedback coupled with a newsletter upon outpatient prescribing charges. Med Care . 1988;;26:88-93.
58 +
Hershey CO, Porter DK, Breslau D, Cohen DI.  Influence of simple computerized feedback on prescription charges in an ambulatory clinic. Med Care . 1986;;24:472-481.
59 +
Jennett PA, Laxdal OE, Hayton RC, et al.  The effects of continuing medical education on family doctor performance in office practice: a randomized control study. Med Educ . 1988;;22:139-145.
60 +
Kottke TE, Brekke ML, Solberg LI, Hughes JR.  A randomized trial to increase smoking intervention by physicians: doctors helping smokers, round I. JAMA . 1989;;261:2101-2106.
61 +
Levinson W.  The effects of two continuing medical education programs on communication skills of practicing primary care physicians. J Gen Intern Med . 1993;;8:318-324.
62 +
Linn BS.  Continuing medical education: impact on emergency room burn care. JAMA . 1980;;244: 565-570.
63 +
Litzelman DK, Dittus RS, Miller ME, Tierney WM.  Requiring physicians to respond to computerized reminders improves their compliance with preventive care protocols. J Gen Intern Med . 1993;; 8:311-317.
64 +
Lomas J, Enkin M, Anderson GM, Hannah WJ, Vayda E, Singer J.  Opinion leaders vs audit and feedback to implement practice guidelines: delivery after previous cesarean section. JAMA . 1991;; 265:2202-2207.
65 +
Magruder-Habib K, Zung WWK, Feussner JR.  Improving physicians' recognition and treatment of depression in general medical care: result from a randomized clinical trial. Med Care . 1990;;28:239-250.
66 +
Maiman LA, Becker MH, Liptak GS, Nazarian LF, Rounds KA.  Improving pediatricians' compliance-enhancing practices. AJDC . 1988;;142:773-779.
67 +
Manheim LM, Feinglass J, Hughes R, Martin GJ, Conrad K, Hughes EF.  Training house officers to be cost conscious: effects of an educational intervention on charges and length of stay. Med Care . 1990;;28:29-42.
68 +
Martin AR, Wolf MA, Thibodeau LA, Dau V, Braunweld E.  A trial of two strategies to modify the test-ordering behavior of medical residents. N Engl J Med . 1980;;303:1330-1336.
69 +
Marton KI, Tul V, Sox HC Jr.  Modifying test-ordering behavior in the outpatient medical clinic: a controlled trial of two educational interventions. Arch Intern Med . 1985;;145:816-821.
70 +
Mayefsky JH, Foye HR.  Use of a chart audit: teaching well child care to pediatric house officers. Med Educ . 1993;;27:170-174.
71 +
Mazzuca SA, Vinicor F, Einterz RM, Tierney WM, Norton JA, Kalasinski LA.  Effects of the clinical environment on physicians' response to postgraduate medical education. Am Educ Res J . 1990;; 27:473-488.
72 +
McAlister NH, Covvey HD, Tong C, Lee A, Wigle ED.  Randomised controlled trial of computer assisted management of hypertension in primary care. BMJ (Clin Res Ed) . 1986;;293:670-674.
73 +
McConnell TS, Cushing AH, Bankhurst AD, Healy JL, McIlvenna PA, Skipper BJ.  Physician behavior modification using claims data: tetracycline for upper respiratory infection. West J Med . 1982;;137:448-450.
74 +
McDonald CJ.  Use of a computer to detect and respond to clinical events: its effect on clinician behaviour. Ann Intern Med . 1976;;84:162-167.
75 +
McDonald CJ.  Protocol-based computer reminders, the quality of care and the non-perfectability of man. N Engl J Med . 1976;;295:1351-1355.
76 +
McDonald CJ, Hui SL, Smith DM, et al.  Reminders to physicians from an introspective computer medical record. Ann Intern Med . 1984;;100: 130-138.
77 +
McDonald CJ, Wilson GA, McCabe GP Jr.  Physician response to computer reminders. JAMA . 1980;; 244:1579-1581.
78 +
McDowell I, Newell C, Rosser W.  Computerized reminders to encourage cervical screening in family practice. J Fam Pract . 1989;;28:420-424.
79 +
McPhee SJ, Bird JA, Fordham D, Rodnick JE, Osborn EH.  Promoting cancer prevention activities by primary care physicians. JAMA . 1991;;266: 538-544.
80 +
McPhee SJ, Bird JA, Jenkins CN, Fordham D.  Promoting cancer screening: a randomized, controlled trial of three interventions. Arch Intern Med . 1989;;149:1866-1872.
81 +
Meyer TJ, Van Kooten D, Marsh S, Prochazka AV.  Reduction of polypharmacy by feedback to clinicians. J Gen Intern Med . 1991;;6:133-135.
82 +
Morgan M.  Computerized concurrent review of prenatal care. Q Rev Bull . 1978;;4:33-36.
83 +
Norton PG, Dempsey LJ.  Self-audit: its effect on quality of care. J Fam Pract . 1985;;21:289-291.
84 +
Palmer RH, Louis TA, Hsu L, et al.  A randomized controlled trial of quality assurance in sixteen ambulatory care practices. Med Care . 1985;; 23:751-770.
85 +
Perera DR, LoGerfo JP, Shulenberger E, Yl-visaker JT, Kirz HL.  Teaching sigmoidoscopy to primary care physicians: a controlled study of continuing medical education. J Fam Pract . 1983;;16:785-788.
86 +
Pierce M, Lundy S, Palanisamy A, Winning S, King J.  Prospective randomised controlled trial of methods of call and recall for cervical cytology screening. BMJ . 1989;;299:160-162.
87 +
Pinkerton RE, Tinanoff N, Willms JL, Tapp JT.  Resident physician performance in a continuing education format: does newly acquired knowledge improve patient care? JAMA . 1980;;244:2183-2185.
88 +
Pollack MM, Getson PR.  Pediatric critical care cost containment: combined actuarial and clinical program. Crit Care Med . 1991;;19:12-20.
89 +
Pozen MW, D'Agostino RB, Mitchell JB, et al.  The usefulness of a predictive instrument to reduce inappropriate admissions to the coronary care unit. Ann Intern Med . 1980;;92:238-242.
90 +
Pozen MW, D'Agostino RB, Selker HP, Sytkowski PA, Hood WB Jr.  A predictive instrument to improve coronary-care-unit admission practices in acute ischemic heart disease: a prospective multicenter clinical trial. N Engl J Med . 1984;;310:1273-1278.
91 +
Pugh JA, Frazier LM, DeLong E, Wallace AG, Ellenbogen P, Linfors E.  Effect of daily charge feedback on inpatient charges and physician knowledge and behavior. Arch Intern Med . 1989;;149:426-429.
92 +
Putnam RW, Curry L.  Impact of patient care appraisal on physician behaviour in the office setting. Can Med Assoc J . 1985;;132:1025-1029.
93 +
Putnam RW, Curry L.  Physicians' participation in establishing criteria for hypertension management in the office: will patient outcomes be improved? Can Med Assoc J . 1989;;140:806-809.
94 +
Rabin DL, Boekeloo BO, Marx ES, Bowman MA, Russell NK, Willis AG.  Improving office-based physicians' prevention practices for sexually transmitted diseases. Ann Intern Med . 1994;;121:513-519.
95 +
Raisch DW, Bootman JL, Larson LN, McGhan WF.  Improving antiulcer agent prescribing in a health maintenance organization. Am J Hosp Pharm . 1990;;47:1766-1773.
96 +
Restuccia JD.  The effect of concurrent feedback in reducing inappropriate hospital utilization. Med Care . 1982;;20:46-62.
97 +
Rogers JL.  Medical information systems: assessing impact in areas of hypertension, obesity, and renal disease. Med Care . 1982;;20:63-74.
98 +
Rosser WW, McDowell I, Newell C.  Use of reminders for preventive procedures in family medicine. Can Med Assoc J . 1991;;145:807-814.
99 +
Rubenstein LV, Calkins DR, Young RT, et al.  Improving patient function: a randomized trial of functional disability screening. Ann Intern Med . 1989;;111:836-842.
100 +
Sanazaro PJ, Worth RM.  Concurrent quality assurance in hospital care: report of a study by private initiative in PSRO. N Engl J Med . 1978;; 298:1171-1177.
101 +
Sibley JC, Sackett DL, Neufeld V, Gerrard B, Rudnick KV, Fraser W.  A randomized trial of continuing medical education. N Engl J Med . 1982;; 306:511-515.
102 +
Soumerai SB, Salem-Schatz S, Avorn J, Casteris CS, Ross-Degnan D, Popovsky MA.  A controlled trial of educational outreach to improve blood transfusion practice. JAMA . 1993;;270:961-966.
103 +
Steele MA, Bess DT, Franse VL, Graber SE.  Cost effectiveness of two interventions for reducing outpatient prescribing costs. DICP . 1989;;23: 497-500.
104 +
Stross JK.  Evaluation of a continuing education program in rheumatoid arthritis. Arthritis Rheum . 1980;;23:846-849.
105 +
Stross JK, Bole GG.  Evaluation of an educational program for primary care practitioners, on the management of osteoarthritis. Arthritis Rheum . 1985;;28:108-111.
106 +
Stross JK, Hiss RG, Watts CM, Davis WK, MacDonald R.  Continuing education in pulmonary disease for primary-care physicians. Am Rev Respir Dis . 1983;;127:739-746.
107 +
Sulmasy DP, Geller G, Faden R, Levine DM.  The quality of mercy: caring for patients with 'do not resuscitate' orders. JAMA . 1992;;267:682-686.
108 +
Szczepura A, Wilmot J, Davies C, Fletcher J.  Effectiveness and cost of different strategies for information feedback in general practice. Br J Gen Pract . 1994;;44:19-24.
109 +
Tape TG, Campbell JR.  Computerized medical records and preventive health care: success depends on many factors. Am J Med . 1993;;94:619-625.
110 +
Tierney WM, Hui SL, McDonald CJ.  Delayed feedback of physician performance versus immediate reminders to perform preventive care. Med Care . 1986;;24:659-666.
111 +
Tierney WM, McDonald CJ, Hui SL, Martin DK.  Computer predictions of abnormal test results: effects on outpatient testing. JAMA . 1988;;259:1194-1198.
112 +
Tierney WM, Miller ME, McDonald CJ.  The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. N Engl J Med . 1990;;322:1499-1504.
113 +
Turner RC, Waivers LE, O'Brien K.  The effect of patient-carried reminder cards on the performance of health maintenance measures. Arch Intern Med . 1990;;150:645-647.
114 +
Vinicor F, Cohen SJ, Mazzuca SA, et al.  Diabetes: a randomized trial of the effects of physician and/or patient education on diabetes patient outcomes. J Chronic Dis . 1987;;40:345-356.
115 +
Weingarten MA, Bazel D, Shannon HS.  Computerized protocol for preventive medicine: a controlled self-audit in family practice. Fam Pract . 1989;;6:120-124.
116 +
Wexler JR.  Impact of a system of computer-assisted diagnosis. AJDC . 1975;;129:203-205.
117 +
White CW, Albanese MA, Brown DD, Caplan RM.  The effectiveness of continuing medical education in changing the behaviour of physicians caring for patients with acute myocardial infarction. Ann Intern Med . 1985;;102:686-692.
118 +
White PT, Pharoah CA, Anderson HR, Freeling P.  Randomized controlled trial of small group education on the outcome of chronic asthma in general practice. J R Coll Gen Pract . 1989;;39:182-186.
119 +
Wigton RS, Zimmer JL, Wigton JH, Patil KD.  Chart reminders in the diagnosis of anemia. JAMA . 1981;;245:1745-1747.
120 +
Wilson DM, Taylor DW, Gilbert JR, et al.  A randomized trial of a family physician intervention for smoking cessation. JAMA . 1988;;260:1570-1574.
121 +
Winickoff RN, Coltin KL, Morgan MM, Buxbaum RC, Barnett GO.  Improving physician performance through peer comparison feedback. Med Care . 1984;;22:527-534.
122 +
Winickoff RN, Wilner S, Neisuler R, Barnett GO.  Limitation of provider interventions in hypertension quality assurance. Am J Public Health . 1985;;75:43-46.
123 +
Wones RG.  Failure of low-cost audits with feedback to reduce laboratory test utilization. Med Care . 1987;;25:78-82.
124 +
Oxman AD, Guyatt GH.  A consumers guide to subgroup analyses. Ann Intern Med . 1992;;116:78-84.
125 +
American Medical Association. Physician Characteristics and Distribution in the USA . Chicago, Ill: American Medical Association; January 1, 1995;.
126 +
Evidence-Based Medicine Working Group.  Evidence-based medicine: a new approach to teaching the practice of medicine. JAMA . 1992;;268:2420-2425.
127 +
Green L, Kreuter M, Deeds S, Partridge K. Health Education Planning: A Diagnostic Approach . Palo Alto, Calif: Mayfield Press; 1980;.
128 +
Rogers EM. Diffusion of Innovation . New York, NY: The Free Press; 1983;.
129 +
Nowlen PM. A New Approach to Continuing Education for Business and the Professions . New York, NY: Macmillan; 1988;.
130 +
Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory . Englewood Cliffs, NJ: Prentice-Hall; 1986;.
131 +
Fox RD, Mazmanian PE, Putnam RW. Changing and Learning in the Lives of Physicians . New York, NY: Praeger; 1989;.
132 +
American Medical Association. The CME Directory . Chicago, Ill: American Medical Association; 1994;.
133 +
Freemantle N, Grilli R, Grimshaw J, Oxman AD.  The Cochrane Collaboration on Effective Professional Practice. Q Health Care . 1995;;4:45-47.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
References 17, 19, 35, 71, 74, 84, 86, 110, 111.
2 +
References 14,20,27,31,37,41,56,57,80,85,89, 91, 93-96, 105, 106, 108, 112.
3 +
References 17, 22,26,29,34,52,63-66,71,75, 78, 79, 86, 87, 98-102, 104.
4 +
References 19, 31, 42, 46, 58, 59, 70, 72, 85, 99.
5 +
References 19, 38, 41, 80, 85, 92, 97, 111, 112.
6 +
References 27,30,33,37,39, 41,48,55,57,58,65, 68, 70, 83, 84, 89, 96, 102, 106, 110.
7 +
References 19, 33, 38, 40, 44, 47, 60, 76, 82, 97, 105, 107.
8 +
References 14, 18, 20, 26, 28, 33, 39, 44, 53, 56, 60-62, 69, 73, 77, 81, 91, 103, 109.
9 +
References 21, 26, 29, 34, 39, 48, 52, 59, 66, 68, 69, 73, 75, 87, 98, 99, 102, 104, 110.
10 +
References 19, 20, 28, 31, 37, 41, 56-58, 77, 85,100, 101.
11 +
References 15, 16, 22, 42, 46, 62, 70, 84, 91, 92.
12 +
Amara R, Morrison JI, Schmid G. Looking Ahead at American Health Care . Institute for the Future, Healthcare Information Center, Washington, DC: McGraw-Hill International Book Co; 1988;.
13 +
Association of American Medical Colleges.  Roles for medical education in health care reform. Acad Med . 1994;;69:512-515.
14 +
Pories WJ, Smout JC, Morris A, Lewkow VE.  US health care reform: will it change postgraduate surgical education? World J Surg . 1994;;18:745-752.
15 +
Haynes RB, Davis DA, McKibbon A, Tugwell P.  A critical appraisal of the efficacy of continuing medical education. JAMA . 1984;;251:61-64.
16 +
Davis DA, Thomson MA, Oxman AD, Haynes RB.  Evidence for the effectiveness of CME: a review of 50 randomized controlled trials. JAMA . 1992;;268:1111-1117.
17 +
Lau J, Antman EM, Jimenez-Silva J, Kupelnick B, Mosteller F, Chalmers TC.  Cumulative meta-analysis of therapeutic trials for myocardial infarction. N Engl J Med . 1992;;327:248-254.
18 +
Jay SJ, Anderson JG.  Continuing medical education and public policy in an era of health care reform. J Contin Educ Health Profess . 1993;;13:195-209.
19 +
Oxman AD, Thomson MA, Haynes RB, Davis DA.  No magic bullets: a systematic review of 102 trials of interventions to help health care professionals deliver services more effectively and efficiently. Can Med Assoc J . In press.
20 +
Bertram DA, Brooks-Bertram PA.  The evaluation of continuing medical education: a literature review. Health Educ Monogr . 1977;;5:330-362.
21 +
Beaudry JS.  The effectiveness of continuing medical education: a quantitative synthesis. J Contin Educ Health Profess . 1989;;9:285-307.
22 +
McLaughlin PJ, Donaldson JF.  Evaluation of continuing medical education programs: a selected literature, 1984-1988. J Contin Educ Health Profess . 1991;;11:65-84.
23 +
Cochrane Collaboration. Optimal MEDLINE Search Strategy for Identifying Randomized Clinical Trials (RCTs): Cochrane Collaboration Handbook . Oxford, England: UK Cochrane Centre; 1994;: 29.
24 +
Davis DA, Fox RD, eds. The Physician as Learner: Linking Research to Practice . Chicago, Ill: American Medical Association Press; 1994;:xiii.
25 +
Anderson FA Jr, Wheeler HB, Goldberg RJ, Hosmer DW, Forcier A, Patwardhan NA.  Changing clinical practice: prospective study of the impact of continuing medical education and quality assurance programs on use of prophylaxis for venous thromboembolism. Arch Intern Med . 1994;; 154:669-677.
26 +
Avorn J, Soumerai SB.  Improving drug-therapy decisions through educational outreach: a randomized controlled trial of academically based 'detailing.' N Engl J Med . 1983;;308:1457-1463.
27 +
Avorn J, Soumerai SB, Everitt DE, et al.  A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes. N Engl J Med . 1992;;327:168-173.
28 +
Barnett GO.  A computer based monitoring system for follow-up of elevated blood pressure. Med Care . 1983;;21:400-409.
29 +
Bass MJ, McWhinney IR, Donner A.  Do family physicians need medical assistants to detect and manage hypertension? Can Med Assoc J . 1986;;134: 1247-1255.
30 +
Berwick DM, Coltin KL.  Feedback reduces test use in a health maintenance organization. JAMA . 1986;;255:1450-1454.
31 +
Billi JE, Hejna GF, Wolf FM, Shapiro LR, Stross JK.  The effects of a cost-education program on hospital charges. J Gen Intern Med . 1987;;2:306-311.
32 +
Brimberry R.  Vaccination of high-risk patients for influenza: a comparison of telephone and mail reminder methods. J Fam Pract . 1988;;26:397-400.
33 +
Britton ML, Lurvey PL.  Impact of medication profile review on prescribing in a general medicine clinic. Am J Public Health . 1991;;48:265-270.
34 +
Browner WS, Baron RB, Solkowitz S, Adler LJ, Gullion DS.  Physician management of hypercholesterolemia: a randomized trial of continuing medical education. West J Med . 1994;;161:572-578.
35 +
Buntinx F.  Does feedback improve the quality of cervical smears? a randomized controlled trial. Br J Gen Pract . 1993;;43:194-198.
36 +
Callahan CM, Hendrie HC, Dittus RS, Brater DC, Hui SL, Tierney WM.  Improving treatment of late life depression in primary care: a randomized clinical trial. J Am Geriatr Soc . 1994;;42:839-846.
37 +
Chambers CV, Balaban DJ, Carlson BL.  Microcomputer-generated reminders: improving the compliance of primary care physicians with mammography screening guidelines. J Fam Pract . 1989;; 29:273-280.
38 +
Chase CR.  Medical information management: improving the transfer of research results to pre-surgical evaluation. Med Care . 1983;;21:410-424.
39 +
Chassin MR, McCue SM.  A randomized trial of medical quality assurance: improving physicians' use of pelvimetry. JAMA . 1986;;256:1012-1016.
40 +
Cheney C, Ramsdell JW.  Effect of medical records' checklists on implementation of periodic health measures. Am J Med . 1987;;83:129-136.
41 +
Cockburn J, Ruth D, Silagy C, et al.  Randomised trial of three approaches for marketing smoking cessation programmes to Australian general practitioners. BMJ . 1992;;304:691-694.
42 +
Cohen DI, Jones P, Littenberg B, Neuhauser D.  Does cost information availability reduce physician test usage? a randomized clinical trial with unexpected findings. Med Care . 1982;;20:286-292.
43 +
Cohen SJ, Christen AG, Katz BP, et al.  Counseling medical and dental patients about cigarette smoking: the impact of nicotine gum and chart reminders. Am J Public Health . 1987;;77:313-316.
44 +
Cohen SJ, Weinberger M, Hui SL, Tierney WM, McDonald CJ.  The impact of reading on physicians' nonadherence to recommended standards of medical care. Soc Sci Med . 1985;;21:909-914.
45 +
Cowan JA.  Effect of a fact sheet reminder on performance of the periodic health examination: a randomized controlled trial. Am J Prev Med . 1992;; 8:104-109.
46 +
Cummings SR, Coates TJ, Richard RJ, et al.  Training physicians in counselling about smoking cessation: a randomized trial of the 'Quit for Life' program. Ann Intern Med . 1989;;110:640-647.
47 +
Cummings SR, Richard RJ, Duncan CL, et al.  Training physicians about smoking cessation: a controlled trial in private practice. J Gen Intern Med . 1989;;4:482-489.
48 +
Davidoff F, Goodspeed R, Clive J.  Changing test ordering behavior: a randomized controlled trial comparing probabilistic reasoning with cost-containment education. Med Care . 1989;;27:45-58.
49 +
Dickinson JC.  Improving hypertension control: impact of computer feedback and physician education. Med Care . 1981;;19:843-854.
50 +
Dietrich AJ.  Cancer: improving early detection and prevention, a community practice randomised trial. BMJ . 1992;;304:687-691.
51 +
Evans CE, Haynes RB, Birkett NJ, et al.  Does a mailed continuing education program improve physician performance? results of a randomized trial in antihypertensive care. JAMA . 1986;;255:501-504.
52 +
Everett GD, deBlois CS, Chang PF, Holets T.  Effect of cost education, cost audits, and faculty chart review on the use of laboratory services. Arch Intern Med . 1983;;143:942-944.
53 +
Gehlbach SH, Wilkinson WE, Hammond WE, et al.  Improving drug prescribing in a primary care practice. Med Care . 1984;;22:193-201.
54 +
Gullion DS, Tschann JM, Adamson TE, Coates TJ.  Management of hypertension in private practice: a randomized controlled trial in continuing medical education. J Contin Educ Health Profess . 1988;;8:239-255.
55 +
Headrick LA, Speroff T, Pelecanos HI, Cebul RD.  Efforts to improve compliance with the National Cholesterol Education Program guidelines: results of a randomized controlled trial. Arch Intern Med . 1992;;152:2490-2496.
56 +
Heale J, Davis DA, Norman GR, Woodward C, Neufeld VR, Dodd P.  A randomized controlled trial assessing the impact of problem based versus didactic teaching methods in CME. Proc Annu Conf Res Med Educ . 1988;;27:72-77.
57 +
Hershey CO, Goldberg HI, Cohen DI.  The effect of computerized feedback coupled with a newsletter upon outpatient prescribing charges. Med Care . 1988;;26:88-93.
58 +
Hershey CO, Porter DK, Breslau D, Cohen DI.  Influence of simple computerized feedback on prescription charges in an ambulatory clinic. Med Care . 1986;;24:472-481.
59 +
Jennett PA, Laxdal OE, Hayton RC, et al.  The effects of continuing medical education on family doctor performance in office practice: a randomized control study. Med Educ . 1988;;22:139-145.
60 +
Kottke TE, Brekke ML, Solberg LI, Hughes JR.  A randomized trial to increase smoking intervention by physicians: doctors helping smokers, round I. JAMA . 1989;;261:2101-2106.
61 +
Levinson W.  The effects of two continuing medical education programs on communication skills of practicing primary care physicians. J Gen Intern Med . 1993;;8:318-324.
62 +
Linn BS.  Continuing medical education: impact on emergency room burn care. JAMA . 1980;;244: 565-570.
63 +
Litzelman DK, Dittus RS, Miller ME, Tierney WM.  Requiring physicians to respond to computerized reminders improves their compliance with preventive care protocols. J Gen Intern Med . 1993;; 8:311-317.
64 +
Lomas J, Enkin M, Anderson GM, Hannah WJ, Vayda E, Singer J.  Opinion leaders vs audit and feedback to implement practice guidelines: delivery after previous cesarean section. JAMA . 1991;; 265:2202-2207.
65 +
Magruder-Habib K, Zung WWK, Feussner JR.  Improving physicians' recognition and treatment of depression in general medical care: result from a randomized clinical trial. Med Care . 1990;;28:239-250.
66 +
Maiman LA, Becker MH, Liptak GS, Nazarian LF, Rounds KA.  Improving pediatricians' compliance-enhancing practices. AJDC . 1988;;142:773-779.
67 +
Manheim LM, Feinglass J, Hughes R, Martin GJ, Conrad K, Hughes EF.  Training house officers to be cost conscious: effects of an educational intervention on charges and length of stay. Med Care . 1990;;28:29-42.
68 +
Martin AR, Wolf MA, Thibodeau LA, Dau V, Braunweld E.  A trial of two strategies to modify the test-ordering behavior of medical residents. N Engl J Med . 1980;;303:1330-1336.
69 +
Marton KI, Tul V, Sox HC Jr.  Modifying test-ordering behavior in the outpatient medical clinic: a controlled trial of two educational interventions. Arch Intern Med . 1985;;145:816-821.
70 +
Mayefsky JH, Foye HR.  Use of a chart audit: teaching well child care to pediatric house officers. Med Educ . 1993;;27:170-174.
71 +
Mazzuca SA, Vinicor F, Einterz RM, Tierney WM, Norton JA, Kalasinski LA.  Effects of the clinical environment on physicians' response to postgraduate medical education. Am Educ Res J . 1990;; 27:473-488.
72 +
McAlister NH, Covvey HD, Tong C, Lee A, Wigle ED.  Randomised controlled trial of computer assisted management of hypertension in primary care. BMJ (Clin Res Ed) . 1986;;293:670-674.
73 +
McConnell TS, Cushing AH, Bankhurst AD, Healy JL, McIlvenna PA, Skipper BJ.  Physician behavior modification using claims data: tetracycline for upper respiratory infection. West J Med . 1982;;137:448-450.
74 +
McDonald CJ.  Use of a computer to detect and respond to clinical events: its effect on clinician behaviour. Ann Intern Med . 1976;;84:162-167.
75 +
McDonald CJ.  Protocol-based computer reminders, the quality of care and the non-perfectability of man. N Engl J Med . 1976;;295:1351-1355.
76 +
McDonald CJ, Hui SL, Smith DM, et al.  Reminders to physicians from an introspective computer medical record. Ann Intern Med . 1984;;100: 130-138.
77 +
McDonald CJ, Wilson GA, McCabe GP Jr.  Physician response to computer reminders. JAMA . 1980;; 244:1579-1581.
78 +
McDowell I, Newell C, Rosser W.  Computerized reminders to encourage cervical screening in family practice. J Fam Pract . 1989;;28:420-424.
79 +
McPhee SJ, Bird JA, Fordham D, Rodnick JE, Osborn EH.  Promoting cancer prevention activities by primary care physicians. JAMA . 1991;;266: 538-544.
80 +
McPhee SJ, Bird JA, Jenkins CN, Fordham D.  Promoting cancer screening: a randomized, controlled trial of three interventions. Arch Intern Med . 1989;;149:1866-1872.
81 +
Meyer TJ, Van Kooten D, Marsh S, Prochazka AV.  Reduction of polypharmacy by feedback to clinicians. J Gen Intern Med . 1991;;6:133-135.
82 +
Morgan M.  Computerized concurrent review of prenatal care. Q Rev Bull . 1978;;4:33-36.
83 +
Norton PG, Dempsey LJ.  Self-audit: its effect on quality of care. J Fam Pract . 1985;;21:289-291.
84 +
Palmer RH, Louis TA, Hsu L, et al.  A randomized controlled trial of quality assurance in sixteen ambulatory care practices. Med Care . 1985;; 23:751-770.
85 +
Perera DR, LoGerfo JP, Shulenberger E, Yl-visaker JT, Kirz HL.  Teaching sigmoidoscopy to primary care physicians: a controlled study of continuing medical education. J Fam Pract . 1983;;16:785-788.
86 +
Pierce M, Lundy S, Palanisamy A, Winning S, King J.  Prospective randomised controlled trial of methods of call and recall for cervical cytology screening. BMJ . 1989;;299:160-162.
87 +
Pinkerton RE, Tinanoff N, Willms JL, Tapp JT.  Resident physician performance in a continuing education format: does newly acquired knowledge improve patient care? JAMA . 1980;;244:2183-2185.
88 +
Pollack MM, Getson PR.  Pediatric critical care cost containment: combined actuarial and clinical program. Crit Care Med . 1991;;19:12-20.
89 +
Pozen MW, D'Agostino RB, Mitchell JB, et al.  The usefulness of a predictive instrument to reduce inappropriate admissions to the coronary care unit. Ann Intern Med . 1980;;92:238-242.
90 +
Pozen MW, D'Agostino RB, Selker HP, Sytkowski PA, Hood WB Jr.  A predictive instrument to improve coronary-care-unit admission practices in acute ischemic heart disease: a prospective multicenter clinical trial. N Engl J Med . 1984;;310:1273-1278.
91 +
Pugh JA, Frazier LM, DeLong E, Wallace AG, Ellenbogen P, Linfors E.  Effect of daily charge feedback on inpatient charges and physician knowledge and behavior. Arch Intern Med . 1989;;149:426-429.
92 +
Putnam RW, Curry L.  Impact of patient care appraisal on physician behaviour in the office setting. Can Med Assoc J . 1985;;132:1025-1029.
93 +
Putnam RW, Curry L.  Physicians' participation in establishing criteria for hypertension management in the office: will patient outcomes be improved? Can Med Assoc J . 1989;;140:806-809.
94 +
Rabin DL, Boekeloo BO, Marx ES, Bowman MA, Russell NK, Willis AG.  Improving office-based physicians' prevention practices for sexually transmitted diseases. Ann Intern Med . 1994;;121:513-519.
95 +
Raisch DW, Bootman JL, Larson LN, McGhan WF.  Improving antiulcer agent prescribing in a health maintenance organization. Am J Hosp Pharm . 1990;;47:1766-1773.
96 +
Restuccia JD.  The effect of concurrent feedback in reducing inappropriate hospital utilization. Med Care . 1982;;20:46-62.
97 +
Rogers JL.  Medical information systems: assessing impact in areas of hypertension, obesity, and renal disease. Med Care . 1982;;20:63-74.
98 +
Rosser WW, McDowell I, Newell C.  Use of reminders for preventive procedures in family medicine. Can Med Assoc J . 1991;;145:807-814.
99 +
Rubenstein LV, Calkins DR, Young RT, et al.  Improving patient function: a randomized trial of functional disability screening. Ann Intern Med . 1989;;111:836-842.
100 +
Sanazaro PJ, Worth RM.  Concurrent quality assurance in hospital care: report of a study by private initiative in PSRO. N Engl J Med . 1978;; 298:1171-1177.
101 +
Sibley JC, Sackett DL, Neufeld V, Gerrard B, Rudnick KV, Fraser W.  A randomized trial of continuing medical education. N Engl J Med . 1982;; 306:511-515.
102 +
Soumerai SB, Salem-Schatz S, Avorn J, Casteris CS, Ross-Degnan D, Popovsky MA.  A controlled trial of educational outreach to improve blood transfusion practice. JAMA . 1993;;270:961-966.
103 +
Steele MA, Bess DT, Franse VL, Graber SE.  Cost effectiveness of two interventions for reducing outpatient prescribing costs. DICP . 1989;;23: 497-500.
104 +
Stross JK.  Evaluation of a continuing education program in rheumatoid arthritis. Arthritis Rheum . 1980;;23:846-849.
105 +
Stross JK, Bole GG.  Evaluation of an educational program for primary care practitioners, on the management of osteoarthritis. Arthritis Rheum . 1985;;28:108-111.
106 +
Stross JK, Hiss RG, Watts CM, Davis WK, MacDonald R.  Continuing education in pulmonary disease for primary-care physicians. Am Rev Respir Dis . 1983;;127:739-746.
107 +
Sulmasy DP, Geller G, Faden R, Levine DM.  The quality of mercy: caring for patients with 'do not resuscitate' orders. JAMA . 1992;;267:682-686.
108 +
Szczepura A, Wilmot J, Davies C, Fletcher J.  Effectiveness and cost of different strategies for information feedback in general practice. Br J Gen Pract . 1994;;44:19-24.
109 +
Tape TG, Campbell JR.  Computerized medical records and preventive health care: success depends on many factors. Am J Med . 1993;;94:619-625.
110 +
Tierney WM, Hui SL, McDonald CJ.  Delayed feedback of physician performance versus immediate reminders to perform preventive care. Med Care . 1986;;24:659-666.
111 +
Tierney WM, McDonald CJ, Hui SL, Martin DK.  Computer predictions of abnormal test results: effects on outpatient testing. JAMA . 1988;;259:1194-1198.
112 +
Tierney WM, Miller ME, McDonald CJ.  The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. N Engl J Med . 1990;;322:1499-1504.
113 +
Turner RC, Waivers LE, O'Brien K.  The effect of patient-carried reminder cards on the performance of health maintenance measures. Arch Intern Med . 1990;;150:645-647.
114 +
Vinicor F, Cohen SJ, Mazzuca SA, et al.  Diabetes: a randomized trial of the effects of physician and/or patient education on diabetes patient outcomes. J Chronic Dis . 1987;;40:345-356.
115 +
Weingarten MA, Bazel D, Shannon HS.  Computerized protocol for preventive medicine: a controlled self-audit in family practice. Fam Pract . 1989;;6:120-124.
116 +
Wexler JR.  Impact of a system of computer-assisted diagnosis. AJDC . 1975;;129:203-205.
117 +
White CW, Albanese MA, Brown DD, Caplan RM.  The effectiveness of continuing medical education in changing the behaviour of physicians caring for patients with acute myocardial infarction. Ann Intern Med . 1985;;102:686-692.
118 +
White PT, Pharoah CA, Anderson HR, Freeling P.  Randomized controlled trial of small group education on the outcome of chronic asthma in general practice. J R Coll Gen Pract . 1989;;39:182-186.
119 +
Wigton RS, Zimmer JL, Wigton JH, Patil KD.  Chart reminders in the diagnosis of anemia. JAMA . 1981;;245:1745-1747.
120 +
Wilson DM, Taylor DW, Gilbert JR, et al.  A randomized trial of a family physician intervention for smoking cessation. JAMA . 1988;;260:1570-1574.
121 +
Winickoff RN, Coltin KL, Morgan MM, Buxbaum RC, Barnett GO.  Improving physician performance through peer comparison feedback. Med Care . 1984;;22:527-534.
122 +
Winickoff RN, Wilner S, Neisuler R, Barnett GO.  Limitation of provider interventions in hypertension quality assurance. Am J Public Health . 1985;;75:43-46.
123 +
Wones RG.  Failure of low-cost audits with feedback to reduce laboratory test utilization. Med Care . 1987;;25:78-82.
124 +
Oxman AD, Guyatt GH.  A consumers guide to subgroup analyses. Ann Intern Med . 1992;;116:78-84.
125 +
American Medical Association. Physician Characteristics and Distribution in the USA . Chicago, Ill: American Medical Association; January 1, 1995;.
126 +
Evidence-Based Medicine Working Group.  Evidence-based medicine: a new approach to teaching the practice of medicine. JAMA . 1992;;268:2420-2425.
127 +
Green L, Kreuter M, Deeds S, Partridge K. Health Education Planning: A Diagnostic Approach . Palo Alto, Calif: Mayfield Press; 1980;.
128 +
Rogers EM. Diffusion of Innovation . New York, NY: The Free Press; 1983;.
129 +
Nowlen PM. A New Approach to Continuing Education for Business and the Professions . New York, NY: Macmillan; 1988;.
130 +
Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory . Englewood Cliffs, NJ: Prentice-Hall; 1986;.
131 +
Fox RD, Mazmanian PE, Putnam RW. Changing and Learning in the Lives of Physicians . New York, NY: Praeger; 1989;.
132 +
American Medical Association. The CME Directory . Chicago, Ill: American Medical Association; 1994;.
133 +
Freemantle N, Grilli R, Grimshaw J, Oxman AD.  The Cochrane Collaboration on Effective Professional Practice. Q Health Care . 1995;;4:45-47.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems